Search

Objectives: To estimate the prevalence of polypharmacy among community-dwelling adults in the UK and determine its association with mortality, hospitalization, adverse drug reactions and falls at one and five years. To also determine the effect of polypharmacy on the outcomes in different patient groups. Methods: A retrospective cohort study was carried out using 1000 patients aged 75 years and above from the Clinical Practice Research Datalink. The study periods for the one- and five-years analysis were January 2010-December 2010 and January 2010-December 2014 respectively. Sociodemographic and clinical variables were retrieved using medical and product codes. Polypharmacy was defined as the use of five or more medicines. The association between polypharmacy and mortality, falls, adverse drug reactions, or hospitalization was determined using cox regression analysis while confounding for age, sex, Charlson's comorbidity index, potentially inappropriate medicines, hospitalization prior to study, and falls prior to study. Subgroup analysis was used to determine the effect of polypharmacy on the outcomes for different patient groups. Key findings: 977 people were reviewed. 36% were male and the mean age was 83 years. The prevalence of polypharmacy was 47%. Adjusted hazard ratios with their 95% confidence intervals for association between polypharmacy and outcomes at five years were: mortality 1.60 (1.30–2.00), hospitalization 1.49 (1.30–1.70), falls 1.49 (0.90–2.40) and adverse drug reactions 0.97 (0.50–1.80). The results for the one-year analysis were mortality 2.37 (1.40–3.90), hospitalization 2.47 (1.40–4.30), and falls 0.37 (0.03–4.00). Conclusion: Polypharmacy was found to be a risk factor for mortality and hospitalization. The risk increased with an increase in age, potentially inappropriate medicines and comorbidities. [ABSTRACT FROM AUTHOR]

Our study aims to investigate if the ratios proposed by Insall-Salvati and Caton-Deschamps follow the theory of normal distribution levels in a healthy population. 434 skeletal mature, healthy knees were obtained from a CT-scan-based modelling system (SOMA). Patellae height ratios were measured using the Insall-Salvati ratio and the Caton-Deschamps index. The patella height ratios of the sample population were plotted on a quantile plot and diagnosed as patella alta, baja or normal using the original ratio definitions. The study population patella height values at the 95th, 98th and 5th centiles were identified and compared to those described as alta or baja by Insall-Salvati and Caton-Deschamps. This meant that if the patient had patella alta, this would be defined as a ratio of ≥ 1.2 and hypothesised that this would align at the 98th centile of the study population, whilst if diagnosed as patella baja (≤ 0.74), this should align at the 5th centile of the population. The inter-rater reliability of both ratios was calculated using kappa statistics. Two authors made all calculations and compared them for consistency using the intraclass correlation coefficient. For the Insall-Salvati ratio, the study population's value at the 98th centile was equivalent to what Insall-Salvati describes as alta, a ratio of ≥ 1.2. In the study population, patients are overdiagnosed if using the Insall-Salvati ratio as patella baja ≤ 0.74, as the value at the 5th centile in the study population was 0.59. Using the Caton-Deschamps index, the 95th centile was 1.3, higher than the patella alta ratio determined by Caton as a ratio ≥ 1.2. Using Caton-Deschamps, patients are being underdiagnosed if utilising a patella baja ratio of ≤ 0.6. In our population, the 5th centile was 0.75. The two ratios had a kappa coefficient of 0.01, which indicates poor inter-rater reliability. Depending on the ratio used, caton-Deschamps and Insall-Salvati ratios diagnose patients as alta or baja differently. The current patella height ratios have originated from very small, select population samples. The future of patella height discussion should begin with data representing large populations. Then, we can discuss the upper and lower limits of abnormality. [ABSTRACT FROM AUTHOR]

Self‐harm is a public health problem and is associated with higher suicidal intent and greater suicidal risk in older adults. This retrospective cross‐sectional study examines psychosocial characteristics, service provision and outcomes in patients attending a mental health liaison service (MHLS) with self‐harm attempt in Lincolnshire. The authors also investigate demographic, psychiatric and clinical factors related to self‐harm and discharge destination. [ABSTRACT FROM AUTHOR]

Classification accuracy of any classifier can be enhanced by performing the classification on selected informative features. Features selection methods are generally approached for the purpose. Combining multiple models known as ensemble method emerged as prominent method for achieving classification accuracy. These techniques can be considered for variable selection for accuracy gain and interpretability of a classifier. we propose an ensemble of penalized logistic models (EPLM) for feature selection. EPLM employs Lasso, adaptive Lasso and elastic net for feature selection. EPLM is applied to high dimensional microarray data sets and simulated data sets. State-of-the-art classifiers, Lasso, Random Forest (RF), Support Vector Machine (SVM) and K- Nearest Neighbors (KNN) are employed for assessment of EPLM. Experimental comparisons reveal that significant improvement in classification accuracy is achieved for all the classifiers considered. The proposed method is also compared to the Ensemble of subset of KNN classifiers (ESKNN). In comparison to ESKNN EPLM achieves better performance accuracy for all the classifiers on simulated and microarray data sets. Moreover, it is also observed that EPLM has selected significantly smaller number of features as compared to the full feature set. [ABSTRACT FROM AUTHOR]

B4C-TiB2 composite was synthesized by in situ reaction of TiO2, C, and B4C during vacuum hot pressing. The composition of the composite was varied from 0 to 20 vol.% TiB2. The reaction step was controlled to produce homogenous distribution of TiB2 in B4C matrix with ~ 100% density. The hardness, bending strength, and fracture toughness of B4C monolith and B4C-TiB2 composite were evaluated. B4C-TiB2 composite with 20 vol.% TiB2 content showed 39.4 GPa hardness, 800 MPa bending strength, and 9.8 MPa.m1/2 fracture toughness. The increase in hardness, bending strength, and fracture toughness in B4C-TiB2 composite sample was 29, 56, and 292%, respectively, as compared to B4C monolith. Improvement in hardness and bending strength is attributed to the smaller grain size, i.e., 1.3 µm. The increase in fracture toughness is due to the presence of free carbon at the B4C-TiB2 interface, which creates micro-cracks at the interfacial boundary. [ABSTRACT FROM AUTHOR]